International Perspective on Influenza Pandemic Preparedness

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International Perspective on Influenza Pandemic
Preparedness
La manifestation Coopération au niveau de la
Confédération en cas de crise dans la domaine de
la Santé Publique

• Presentation by David Nabarro
• UN System Influenza Coordinator
• 13.30 June 29th 2006

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Different Kinds of Influenza focus on Pandemics
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Three Kinds of Influenza
Seasonal Influenza The Flu
Avian Influenza Bird Flu
Pandemic Influenza A Pandemic
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Past Influenza Pandemics
1850
1900
30 40 years cycle
1950
No Pandemic for gt 35 years
2000
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Mortality during the pandemic of 1918-19
A/H1N1 Spanish influenza

• 3 epidemic waves in close succession
• March 1918, Sept 1918, Feb 1919
• Estimate 40 million deaths world-wide

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Geographic spread 1918-19
06/18
?
04/18
03/18
06/18
05/18
?
01/19
06/18
C.W. Potter, Textbook of Influenza, 1998
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Geographic spread 1957-58
06/57
06/57
06/57
02/57
08/57
04/57
07/57
05/57
07/57
C.W. Potter, Textbook of Influenza, 1998
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DETERMINANTS OF PANDEMIC INFLUENZA
A new influenza virus emerges to which the
general population has little/no immunity
The new virus must be able to replicate in humans
and cause disease
NOT TO DATE
The new virus must be efficiently transmitted
from one human to another
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ESTABLISHING PANDEMIC THREAT
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What are the predicted health and economic
impacts of a global influenza pandemic
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Impact of pandemic on global health

• Must distinguish between Seasonal Influenza,
  Avian Influenza and Pandemic Influenza
• Pandemic influenza will happen (at some point)
• It is more likely now than three years ago
• It is most likely to be mild (2 3 million
  deaths)
• Extreme case more than 100 million deaths
• It affects younger age groups than "normal"
  influenza
• Pandemic will come in waves

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Impact of pandemic on global health

• Need for RAPID detection of sustained human to
  human transmission
• Must be contained within three weeks
• Not all nations have mobile containment teams and
  stocks of anti-viral medicines
• Virus may be resistant to antivirals
• An effective pandemic influenza vaccine will take
  several months to develop
• WHO has a global protocol for rapid containment
  of pandemic virus

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Impact of pandemic on global health

• Influenza is infectious but not as highly
  infectious as measles
• Not everyone will be infected
• There are ways of reducing the numbers affected
  Maintain distance, Stay at home
• If an infectious and damaging virus emerges,
  restriction on peoples movement may be justified
• Need for epidemiological information to guide
  action often hard to get such information quickly

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ECONOMIC IMPACT OF PANDEMIC

• The next pandemic will start with local outbreaks
  but will have global impact
• Compare with SARS - lt1000 dead, 50 billion
  economic loss.
• It could lead to significant loss of life and
  high absenteeism in all sectors
• The IMF suggests a significant temporary impact
• markets closed, unreliable utilities and
  telecoms, cash shortages
• Reduced travel and leisure, impact on food
  industry
• There may be threats to Rule of Law, Security,
  and Continuity of Governance

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H5N1 Avian Influenza
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AVIAN INFLUENZA

• Birds frequently affected by influenza
• H5N1 is a highly pathogenic influenza A virus
• Moving across the world affecting domestic
  poultry some asymptomatic carriage by wild
  birds
• More than 30 countries reporting H5N1 since
  January 2006
• 15 countries in the preceding 2.5 years
• Sporadic human cases (gt200)
• Potential (if there is mutation) to cause a
  pandemic
• Most human cases have had contact with infected
  birds
• Virus attaches to receptors in lower respiratory
  tract
• Clusters of Human Cases need careful
  investigation
• The threat is not unique 70 of new human
  infections will come from the animal kingdom

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and FAO
Map courtesy of FAO using data from OIE
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Map prepared By US Government
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Sporadic Human Cases of Avian Influenza

• Since 2003 H5N1 has infected 227 people
• 129 have died, mostly children and young adults.
  
• Human deaths have been confirmed from
  Azerbaijan, Cambodia, China, Egypt, Indonesia,
  Iraq, Thailand, Turkey and Vietnam.
• Vietnam and Indonesia account for 80 of the total
  deaths.
• Human infection with H5N1 is rare, and usually
  the result of virus transmission from birds to
  humans.
• No evidence of mutation to sustained human to
  human transmissibility

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THREE PANDEMIC SCENARIOS
MODEL 3 - Rapid Onset / Widespread impact Little
time for preparation, response is reactive and
defensive
MODEL 2 - Slow Onset / Moderate Localized
Impact Slowly acquires infectivity Containment
may be successful Limited pandemic
Impact
MODEL 1 - Extended Pandemic Phase 3 / Continued
Outbreaks of Avian Influenza Impact on
livelihoods due to culling of birds
Time
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RESPONSE BEYOND HEALTH
Human Survival and Health

• High illness potentially higher death rates
• Overstretched health facilities
• Impact on persons with chronic disease

• Absenteeism affecting manufacture and services
  Interruption of Electricity and Water Supplies
• Telecommunications overload

Basic Services and Utilities

• Increased demand for governance security
• Higher public anxiety, reduced capacity
• Potential exploitation

Rule of Law and Governance

• Diminished coping support mechanisms
• Shortage of basic necessities
• Vulnerabilities needs - of Contained Groups

Vulnerable Livelihoods

• Trade commerce disruptions
• Reduced availability of cash
• Interruption of logistics

Financial Systems And Trade
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Global Preparedness Current Situation
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LESSONS FROM SARS

• Give priority to well-being of front line
  personnel
• Do not withhold information
• Engage communities
• Encourage responsible, science-based and
  effective responses
• Involve media
• Global action is critical
• Harness energies of multiple actors
• Supportive Leadership building effective
  coalitions

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Pandemic Implementation Plans

• Most countries have plans
• Most plans focus on health sector
• Plans should focus on continuity of Government,
  Utilities, Humanitarian relief, financial
  services,
• Importance of Cross-border Planning
• Ideal plans
• All of Government Involved
• Federal, State and Local Tiers
• Link to plans of Private Entities and Voluntary
  Sector
• Engage Military
• Involve Civil Defence
• Priority to Public Information
• Plan Must be Tested
• Action Items Indicated
• Responsible Bodies Identified
• Emphasis on Communicating Information to Public
• Plan Must Be Revised Regularly

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The UNICEF CREATE InitiativePromote 4 actions
now!
Street-wise hygiene campaign
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BEST PRACTICE PANDEMIC PREP.

• Make sure that there is Health Care cover
• Look at the business.
• Establish core functions vital for business
  continuity
• Focus on Economic, Travel, Logistics, Governance,
  and Social issues
• Check out the plans of the local authorities
• Liaise with Community-Based Organizations
• Test procedures for Crisis Management
• Establish protocols for critical cross-country
  actions
• Use simulations to plan for different outcomes
• Do not delay

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PLANNING PROCESS
The Plan
Contingency Prioritization
Hazard/Risk Analysis
Scenario-Building
PreparednessActions PlanMaintenance
What are risks to staff, operational continuity
and operating environment?
Which risks should be planned and prepared for?
How might selected contingencies affect staff,
operational continuity and operating environment?
Prepare and share plan
Plan rehearsal, updating as necessary, new
factors?
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Global Strategy Agreed Nov 2005

• 1 Stop influenza in animals through stamping out
  the disease at the place where the infection
  starts
• 2 Prevent emergence of pandemic by limiting human
  exposure
• if pandemic does start, contain it quickly
• if containment is not possible, mitigate pandemic
  consequences.
• Financing arrangements agreed Jan 2006

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Key International Bodies

• Food and Agriculture Organization
• Crisis Management Centre
• Regional Centres (Bangkok. New Delhi, Bamako,
  Gaborone, Nairobi, Budapest, Buenos Aries)
• Monitoring and Risk Assessment
• World Organization for Animal Health (oiE)
• Standards for animal health
• Reporting systems
• Response strategies

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Key International Bodies

• World Health Organization
• Revised International Health Regulations
• (agreed May 2006)
• Epidemic and Pandemic Alert and Response Team
• Global Outbreak Alert and Response Network
• Other United Nations Bodies (UNICEF, UNDP, WFP,
  OCHA, UNHCR)
• Inter-agency Humanitarian Committee (IASC)
• United Nations General Assembly
• International Partnership on Avian and Pandemic
  Influenza (launched by US Government Sept 05)

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WHAT SHOULD I DO?

• Work through the issue with colleagues
• Participate in Pandemic Simulations
• Make sure that front line personnel get adequate
  support and protection
• Emphasise the importance of keeping essential
  services going
• Prepare to hunker down supplies, stocks six
  weeks?
• Sustain the capacity for a respond of several
  months
• Now is the time to get ready
• Do not get complacent if disease incidence is low

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Much achieved much more to do

• It is up to all of us, together
• We are all held to account

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Thank you david.nabarro_at_undp.orgwww.influenza.u
ndg.org